Long ago (1988) I moved to Berkeley and started sending a monthly "newsletter" to my Boston friends. When I returned to Boston (1993), I continued the tradition for about five more years (or until I had kids). Looking back, I realize that I was actually blogging. Each newsletter contained anywhere from a few to several blog posts. Having been silent for the past decade or so, I've decided to resume these activities. Don't expect anything profound -- I tend to focus on what I find entertaining or amusing and perhaps sometimes informative. We shall see!

Tuesday, July 14, 2015

Total Hip Replacement: The History

When last you left this blogger, I was riding the high of the recent
women's world cup championship. Good thing too -- I definitely needed
something good before embarking on my next journey -- after flying home
from Vancouver on Monday, I had to be at New England Baptist at 5:45 AM
Tuesday morning to get a new (right) hip.

I suppose a bit of background is in order.

I've had pretty constant hip pain for about 16 months at this point, but
being smarter than I was before, I'm guessing the hip problems started
several years ago. Every once in awhile, perhaps every second or third
game, I'd notice that my hip would spontaneously kind of buckle. It was
a quick thing, not terribly painful, and it was fine immediately thereafter,
so I ignored it. This may not have been my most clever move.

Then, starting early last year, the hip started getting sore after games.
It wasn't unbearable, just annoying. I figured it was a sign of aging,
but didn't think a lot about it. Then in the late spring I ran into a woman
who had just returned from a hip replacement and I asked her about early
warning signs. She pretty much described my buckling sensation. This got
me pretty scared, but I had some other medical issues to attend to, so I
ignored it for a bit longer.

Finally in November I sought medical attention.
My normal orthopedist doesn't do hips, so they sent me to a specialty
I'd never heard of: physiatry.
Initial diagnosis was bursitis. That sounded pretty good! That would
be treatable and completely fixable.
The only problem was that the cortisone shot made things considerably worse.
Next step: MRI and XRay.

The results of that showed a torn labrum, a 3 cm cyst, and "mild to moderate"
arthritis.
This was the end of my run in physiatry and I went off to the area specialist
in minimally invasive hip repair (thinking that this torn labrum must be
the culprit). However, within moments of seeing him (we're now at December 24),
he said that the labrum and cyst were the least of my problems, but I had
pretty severe arthritis (flattening or destruction of the cartilage) in the
hip. It didn't take a trained expert to see what he meant -- a well functioning
hip is a ball joint, nicely centered in the pelvic socket with a nice fat
layer of cartilate between the two. My ball socket was only millimeters
from the pelvic socket and definitely not comfortably surrounded by
cartilage.
He sent me off for a slow-acting shot of cortisone into the hip joint and
then PT three weeks later.

My Physical Therapist, Clare Safran-Norton, at the Brigham is awesome! I'd been
trying to find someone to help me figure out why I'd been having repeated
injuries on the left side and no one would take a holistic view, but Clare
did. She immediately started to work with me to bring some flexibility back
into my spine (it had become practically flat after so many months of
compensating for hip pain), she got me working out in the pool, but most of
all, she treated me like a partner and we worked together to see how far
I could get. If you need a PT, I can't say enough good things about her. She is
just terrific.

By the time I had my follow up with the doctor/surgeon, I was still in pretty
constant pain and he broke the news that a replacement was really my only
option.
I wasn't thrilled, but swallowed the answer.
He gave me the number of his scheduler to schedule surgery,
but when I finally got through to her, she said I had to come back
for another appointment and XRay.
When I found this second appointment almost an identical rehash of the
previous appointment, I decided to shop around a bit more for doctors.

I worked my network and got recommendations, did a bunch of searching
online and decided that I probably wanted to get this done at
New England Baptist,
because it's an orthopedic hospital and they do more of these
than pretty much anywhere else.
So I started looking for someone who was both a sports physician and a hip
replacement surgeon.
It turns out that several of the NEBH (New England Baptist Hospital) crew
practice out of an organization called
Pro Sports Orthopedics
and that they see patients in Cambridge, Brighton, and Waltham -- three
terrifically convenient locations.

So I narrowed my list and decided that I wanted to speak with
Anthony Schena
The good news is that I liked him a great deal; the bad news is that he doesn't
actually do hip replacements. Oops -- turns out "Joint reconstruction" is fundamentally
different from "Joint replacement. My bad.
He directed me to his colleague,
Michael Mason.
Liked this guy a lot.
Instead of, "Well, we'll have to see when we can get you in." I got,
"Oh, early July? That should be no problem."
He took the time to draw pictures of the pieces that went into a hip
replacement.
He gave me a good sense of where the technology is, what we know and also
what we don't know (I find this trait particularly attractive in physicians;
it is all too rare).
He was encouraging, and he's clearly active both clinically and I research --
he has a herd of goats prancing around Scotland (I think) with artifical
cartilage. The research is going to take a long time to complete, because
for the next step, the FDA requires that the goats be slaughtered and no one
is keen to do that.
And actually the clincher was when I asked him what brand he uses for replacements,
he named two and said that he picked the one that fit me best.
Very different from earlier interactions, which devolved down to, "I use this part."

OK, so the plan was set: I spend most of June in Canada (see previous blog
sequence), during my trip home in the middle I do my pre-surgical appointment,
and then I land on July 6 and get a new hip on July 7.